Monday, February 27, 2006
What is your general philosophy concerning pregnancy and birth?
How long have you been practicing?
Do you have any children and how were they born?
What are your guidlines for "normal" and "high risk" pregnancies?
Standards of care may vary and different doctors may view different situations as high risk. Having standards of care help the doctor paint a picture of what possible complications might occur.
What routine tests do your require?
Under what circumstances do you require ultrasounds? Quad or AFP screening, chorionic villi sampling, amniocentesis, and glucos tolerance testing?
How often do you perform a cesarean section and for what reasons?
If my baby turns breech, can I give birth vaginally? What do you do to help the baby turn vertex (back to a head down position)?
Do you encourage women who have had one cesarean to give birth vaginally in subsequent pregnancies?
Doctors who are more likely to perform a vaginal birth after cesarean may be more likely to avoid a c section in the first place.
Do you have specific recommendations concerning weight gain, diet, and exercise?
Do you require or suggest that I take a childbirth class?
Do you return calls personally or ask your nurses to call?
What is your rotation policy? How often are you on call ? Who will actually be at my birth? Do I have a choice? Will the other doctors respect agreements that you make with me?
Does the hospital encourage women to follow a birth plan?
How is routine vaginal birth handled at the hospital?
When do I need to check in at the hospital?
Can I labor, give birth, and stay with my baby in the same room?
Do you routinely require an IV?
Do you routinely require electronic fetal monitoring?
How often does someone perform a vaginal exam to assess progress?
What mechanism is in place so that I can refuse routine interventions such as vaginal exams?
How soon after labor begins will you, the doctor, come to see me?
Will you stay with me during labor?
Can my partner stay with me the entire time?
How does the hospital feel about the use of a Doula?
Can other family members or friends be present for the labor and birth?
Does the hospital have showers/baths in each room?
Can I eat and drink during labor?
Do you encourage women to walk, squat, or be on thier hands and knees during labor?
Can I birth the baby in a position of my choice?
Can I use a warm bath for pain relief during my labor? Under what cirucmstances?
Can I stay in the water to birth my baby?
What kind of pain medication do you routinely use?
What kinds of non-pharmacological pain management techniques do you recommend?
If I want an epidural what are your guidelines?
Do you do episiotomies? Why? In what percentage of births?
Do you ever use a vacuum extractor or forceps? Why ? In what percentage of births?
What is your policy regarding stripping or rupturing membranes (bag of waters)?
How long will you let me labor before starting interventions?
How long will you wait to cut the cord and deliver the placenta?
Can my partner cut the cord?
Is it neccessary to put antibiotics in the baby's eyes right away or can we delay that for a few hours to allow for bonding?
Can I have skin to skin contact with my baby immediately following delivery?
Can I breast feed my baby immeidatley after the birth?
Can I delay weighing and measuring the baby for at least an hour?
Can the baby stay with me, room-in?
Do you routinely recommend circumcision?
How soon after the birth can I leave the hosptial?
Sunday, February 26, 2006
This is a hot topic....and I have been amazed at the number of people who ask if midwives perform circumcision. We don't. My experience has been that midwives either feel very clear that the penis should be left intact or that it is the job of the midwife to inform and the choice is the parents. What I have found interesting is that in Oregon, about 60% of boys are not circumcised. This is in part because of progressive views, but also because the procedure is generally not covered by insurance. The AMA decided that the procedure is not longer medically necessary and is now considered cosmetic surgery, making insurance companies less likely to cover the cost. What I would recommend to parents who are considering circumcision is that they educate themselves as to the risks and benefits and that they watch a video of the procedure. A lot of parents don't like the idea of seeing a circumcision performed, but I think that it is important to know what the choices being made look like.
Here is some more information....
What is male circumcision?
Circumcision is the removal of the foreskin of the penis. It usually takes place in the hospital during the fist day of life, or is performed on the eighth day of life by a religious attendant. It may be performed for cultural or religious reasons and beliefs.
Circumcision may be performed in a few different ways. The most common are the Gomco clamp and the Plastibell clamp. In religious ceremonies a Mogen clamp is used. It allows for a quicker procedure, but may have a greater risk of cutting penile anomalies, because the glands of the penis are not visible.
The use of the clamp in the Gomco and Plastibell procedures may allow for greater visibility, but are done at a slower pace, and therefore may be more painful. Both the Gomco clamp and Plastibell clamp procedures are relatively the same, however, the Plastibell clamp has a small, grooved ring that remains around the penis after the circumcision is finished. The ring stays on for approximately one week. With these procedures a probe is used to separate the glands of the penis from the foreskin and a small incision (dorsal cut) is made down the foreskin to allow for the placement of the bell of the Gomco clamp over the glands. The clamp is then put in place. The foreskin that is to be cut sits above the base of the clamp, thus protecting the rest of the penis from being cut. A scalpel is used to remove the foreskin above the base of the Gomco clamp.
The Gomco clamp is thought to have lower infection rates than the use of the Plastibell clamp. Both procedures take more time than the Mogen clamp procedure, but allow for greater visualization of the circumcision.
Circumcision may be performed with no anesthetic. This is not recommended. If you are planning on circumcising your newborn, make sure that an anesthetic is being provided.
Lidocaine is the most common anesthetic. It may be given in the form of a penile nerve block, which involves injecting 1% lidocaine in to the area where the dorsal nerve of the penis begins. The injection itself is painful. Topical or local lidocaine, 2%, is another form of anesthetic. Because it is not an injection, its effects are more superficial. There is no pain from administration, but it may not provide complete pain relief.
What the American Academy of Pediatrics says:
While circumcision may be performed for religious or cultural reasons, the World Health Organization and the American Academy of Pediatrics do not recommend circumcision as a routine procedure. It is considered cosmetic surgery, and therefore may not be covered by your insurance policy.
The American Academy of Pediatrics states: ÂExisting scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these date are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the childÂs current well being, parents should determine what is in the best interest of the child.Â
Circumcision was originally practiced for religious reasons. It involved a mosaic cut, or a small cut above the penile glands in which only the tip of the foreskin was removed.
In the UK circumcision is not commonly practiced because there is little evidence to support it as being beneficial.
It is considered a safe procedure
Bleeding and infection occur in 1% of the cases
It takes about 1 week for the penis to heal
Circumcision is often performed with no anesthesia
Circumcision has been linked to a 50% reduction in penile cancer.
Penile cancer is very rare. 1 in 100,000 men get penile cancer each year.
There is a 1 in 476 chance of complication associated with circumcision.
Disadvantages to circumcision:
It is difficult to prevent the newborn from feeling the pain associated with circumcision. There are several types of anesthesia to help numb the penile area, although some studies question to what extent these anesthetics work. In some instances no anesthetic is used.
Risk of infection
Risk of amputation
Risk of severing the frenulum
Mutilation of the penis or areas of the penis
Increased risk of scaring
Increased risk of scaring leading to sexual dysfunction
Causes fear in the infant
Causes decreased sexual sensitivity
If not covered by insurance, the procedure can be costly.
Advantages to circumcision:
Allows for participation in a cultural custom
May be easier to clean under adverse conditions (where clean water is not available)
No foreskin cancer
Allows for participation in religious beliefs and customs
Newborn can look like dad
Care for the circumcised penis:
Make sure to discuss care with the practitioner conducting the circumcision. Get clear instructions that you understand and find easy to follow.
*The dressing on the penis should be removed after 24 hours.
*If it needs replacing, do so, under the advice or your practitioner.
*If there is excess bleeding be sure to notify a nurse or the doctor immediately.
*Make sure that any dressings placed on the penis are clean.
*Always wash your hands before handling the circumcised area.
*Clean the area with lukewarm water during the first few days.
*DO NOT use soap or alcohol on the penis. This will cause the newborn pain.
*It may take 3 days to 1 week for the penis to heal.
*Do not be surprised if the baby is irritable.
*Provide warm, loving care for the newborn. Tell the baby he is safe and loved.
*Report any signs of redness, swelling, bleeding, or excess pus immediately.
*Signs of infection include lethargy, poor or no feeding, no wet diapers, and a temperature at or above 101 degrees F.
*Arnica and rescue remedy may be given internally; ask your midwife for specific dosage. Arnica gel or ointment can also be given at the base of the shaft, but should not be put on the circumcised area.
Care for the uncircumcised penis:
The tip of the penis should be wiped off and gently washed without retracting the foreskin. Over time, the babyÂs foreskin will retract, even if left alone. By the age of three (and around the time of potty-training), the child should be able to retract the foreskin and taught to clean the penis on his own.
Friday, February 03, 2006
So there are a lot of you that have visited my blog over the last few months....and some of you are clearly citizens for midwifery....so here is the site just for you. Join the community and support your local (or not so local!) midwife...
What is Citizens for Midwifery?
"Citizens for Midwifery is a non-profit, volunteer, grassroots organization. Founded by several mothers in 1996, it is the only national consumer-based group promoting the Midwives Model of Care...
The goal of Citizens for Midwifery is to see that the Midwives Model of Care is available to all childbearing women and universally recognized as the best kind of care for pregnancy and birth. Citizens for Midwifery also endorses the Mother-Friendly Childbirth InitiativeÂ.
If you are interested in maternity care that is ...
* Family Centered
* Health Promoting
* Cost Effective
Then Citizens for Midwifery (CfM) has information and resources you need!
The key is the Midwives Model of Care
At the core of the Midwives Model of Care is deep respect for the normalcy of birth and for the uniqueness of each childbearing woman and her family. This approach to maternity care promotes health and helps to prevent complications. Care providers who practice this model of care have excellent outcomes while providing safe, individualized care.
Access to the Midwives Model of Care is severely limited or nonexistent in many places due to state laws and regulations, hospital policies, economic structures, and misinformation that prevent or discourage qualified caregivers from providing this kind of care.
Citizens for Midwifery works to change those factors that restrict the availability of the Midwives Model of Care.
The Midwives Model of Care
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
* Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
* Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
* Minimizing technological interventions
* Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section."